Tazinya et al.

BMC Pulmonary Medicine (2018) 18:7

DOI 10.1186/s12890-018-0579-7

RESEARCH ARTICLE Open Access

Risk factors for acute respiratory infections

in children under five years attending the
Bamenda Regional Hospital in Cameroon
Alexis A. Tazinya1, Gregory E. Halle-Ekane2*, Lawrence T. Mbuagbaw1, Martin Abanda1, Julius Atashili3
and Marie Therese Obama4

Abstract
Background: Acute respiratory infections (ARI) are a leading cause of morbidity and mortality in under-five children
worldwide. About 6.6 million children less than 5 years of age die every year in the world; 95% of them in low-
income countries and one third of the total deaths is due to ARI. This study aimed at determining the proportion
of acute respiratory infections and the associated risk factors in children under 5 years visiting the Bamenda
Regional Hospital in Cameroon.
Methods: A cross-sectional analytic study involving 512 children under 5 years was carried out from December
2014 to February 2015. Participants were enrolled by a consecutive convenient sampling method. A structured
questionnaire was used to collect clinical, socio-demographic and environmental data. Diagnosis of ARI was based
on the revised WHO guidelines for diagnosing and management of childhood pneumonia. The data was analyzed
using the statistical software EpiInfo™ version 7.
Results: The proportion of ARIs was 54.7% (280/512), while that of pneumonia was 22.3% (112/512). Risk factors
associated with ARI were: HIV infection ORadj 2.76[1.05–7.25], poor maternal education (None or primary only) ORadj
2.80 [1.85–4.35], exposure to wood smoke ORadj 1.85 [1.22–2.78], passive smoking ORadj 3.58 [1.45–8.84] and contact
with someone who has cough ORadj 3.37 [2.21–5.14].
Age, gender, immunization status, breastfeeding, nutritional status, fathers’ education, parents’ age, school
attendance and overcrowding were not significantly associated with ARI.
Conclusion: The proportion of ARI is high and is associated with HIV infection, poor maternal education, exposure
to wood smoke, passive cigarette smoking, and contact with persons having a cough. Control programs should
focus on diagnosis, treatment and prevention of ARIs.
Keywords: Acute, Respiratory infections, Risk factors, Proportion, Under-five

Background total global burden of disease; this is a higher percent-

Acute respiratory infections (ARIs) are a major cause of
morbidity and mortality worldwide [1, 2]. Each year,
about 1.3 million children under 5 years die from acute
respiratory infections worldwide [3]. ARI constitute one
third of the deaths in under five in low income coun-
tries [4]. The World Health Organization (WHO) esti-
mates that respiratory infections account for 6% of the
* Correspondence: halle-ekane.edie@ubuea.cm; gregory@yahoo.fr
2
Department of Surgery and Obstetrics/Gynecology, Faculty of Health
Sciences, University of Buea, P.O Box 12, Buea, Cameroon
Full list of author information is available at the end of the article
age compared with the burden of diarrheal disease,
cancer, human immunodeficiency virus (HIV) infection,
ischemic heart disease or malaria [5]. Each year ARIs
account for over 12 million hospital admissions in
children less than 5 years [6]. In a 16 year study on the
causes and circumstances of death in northern
Cameroon, 67% of all deaths were in children and a
majority 24% (167) of the deaths were caused by ARIs,
followed by malaria 21% (152) and diarrheal diseases
19% (133) making ARIs one of the leading public health
problems in under-fives in Cameroon [7].

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Tazinya et al. BMC Pulmonary Medicine (2018) 18:7
Despite the burden of acute respiratory infection on
morbidity and mortality in children under the age of five
in the world, there is limited data to evaluate the prob-
lem in Cameroon. The availability of data on the propor-
tionand risk factors of ARIs is vital because, achieving
the Sustainable Development Goal on improving health
and wellbeing, will depend on the existing efforts to pre-
vent and control ARIs in all WHO regions [1, 8].
There are many socio-cultural, demographic and en-
vironmental risk factors that predispose children less
than 5 years to acquire Respiratory Tract Infections
(RTIs). Even though many of these risk factors are pre-
ventable [9], they have not been documented in many
regions in Cameroon making it difficult to develop algo-
rithms for the management of this group of patients.
This study therefore aimed at determining the propor-
tion of ARIs and their associated risk factors amongst
children under 5 years of age who attend the Bamenda
Regional Hospital.
Methods
Study design and setting
This was a hospital-based cross-sectional analytic study
carried out in the peak period of the dry season from
December 2014 to February 2015. Bamenda is the capital
of the North West Region. It is located 366 km north-west
of the Cameroonian capital, Yaoundé. It has an estimated
population of about 500,000 inhabitants [10] Bamenda like
other parts of Cameroon has two seasons in a year. The dry
season starts in November and ends by March while the
rainy season starts in April and ends in October. The dry
season is characterized by cool, dry and very dusty harmat-
tan winds which blow during the peak periods of the dry
season (December, January and March), with temperatures
ranging between 9°c and 30°c. Many people in Bamenda
use wood for cooking and this produces smoke rendering
the children vulnerable to its effects.
The Bamenda Regional Hospital (BRH) is the biggest
health care facility in the region receiving about 150 pa-
tients daily, about one-third being children. The hospital is
a second level health facility and serves as a teaching hos-
pital for the Faculty of Health Sciences, of the University of
Bamenda. It has an HIV treatment center with over 80 chil-
dren in care who visit the hospital at least monthly for a re-
fill of their medication. This study was carried out in the
pediatric unit of the Regional Hospital which has a capacity
of 34 and 15 beds for pediatric patients and neonates re-
spectively. It has a level of occupancy of more than 85%
most times of the year [11]. Health care services are pro-
vided by a pediatrician, 3 general practitioners and 15
nurses. Children visiting this hospital benefit from the Ex-
panded Program of Immunisation which offers many vac-
cines for various ages including the influenza vaccine,
pneumococcal vaccine and the measles vaccines.
Page 2 of 8
Sample size calculation
The sample size was calculated using the formula for es-
timating proportions [12]. A pre-study estimate of
prevalence of ARI from a systematic review of literature
from 12 developing countries was 22% [13] with a preci-
sion of 0.036. The calculated sample size w as508. Five
hundred and twelve children were included in the study.
Study population and sampling
All children under 5 years who visited the Bamenda Re-
gional Hospital during the study period and whose parents
or guardians gave consent were included in the study. Chil-
dren less than 2 months were excluded from this study be-
cause the clinical definitions of ARIs have low sensitivity
and specificity in this age group and the clinical presenta-
tion is nonspecific. Children whose parents or guardians
did not give consent were also excluded from the study.
Study procedure
Approach to participants
Participants were recruited between 8 am and 5 pm from
Monday to Saturday from both the out-patient and in-
patient departments. The parents or guardians of the child
were informed about the study at the outpatient waiting
room or in the wards and their written consent sought.
Those who gave their consent to the study were met in
the pediatrician’s consultation room or in the wards and a
designed questionnaire was administered by the principal
investigator. Findings from the consultation were used
and additional information needed was obtained from a
complementary history and physical examination.
Data collection
Data was collected using a structured questionnaire on
the; demographic, clinical and the socioeconomic vari-
ables of the child and the parents or guardians.
Data management
Data was entered, cleaned, and analyzed using the statis-
tical software Epi info version 7.
Case definition for ARI was was based on the Integrated
Management of Childhood Illnesses (IMCI) classification
for children presenting with cough or difficulty breathing.:
Mild ARI (no pneumonia), Moderate ARI (pneumonia) and
Severe ARI (severe pneumonia) [14]. Potential risk factors
included: age, sex, birth weight, co-infection with HIV (di-
agnosed using a rapid test- Determine) passive smoking
(any child living with someone who smokes at home), at-
tendance at day care, exposure to wood smoke (any child
who spends more than 30 min in wood smoke daily), living
in the same house with someone have a cough, poor paren-
tal education (primary school level or less), malnutrition
(Z-scores<2SD), inadequate immunization (if a child was
lacking some vaccines for age) and mixed breastfeeding (if
Tazinya et al. BMC Pulmonary Medicine (2018) 18:7
the child was not exclusively breastfed for at least 4 months)
overcrowding (either ≥6 persons in a house, or ≥3 people
using one bed) [5]. The predictor variables were grouped
into three categories; socio-demographic, environmental,
and clinical factors. The prevalence of ARI in children at-
tending the BRH was calculated as; Number of children 2–
59 months diagnosed with ARI during the study period, di-
vided by the total number of children 2–59 months who
visited the hospital during the same) multiplied by 100%.
The chi square test was used to evaluate significance of
associations between ARI and potential risk factors, which
were coded as categorical variables. The odds ratio (OR)
of having ARI was calculated for all the assessed risk fac-
tors as follows: OR = (a/b)/(c/d) where a = exposed with
ARI, c = not exposed with ARI, b = exposed without ARI,
d = not exposed without ARI.
Multivariable analysis was performed using a logistic
regression model, which included as explanatory vari-
ables all risk factors whose p-value was lower than 0.20
in univariable analysis.
Results
A total of 620 children visited the hospital during the
study period. Forty eight children were under 2 months of
age, 36 parents did not give consent either because they
presented as emergencies or did not want any delay in the
consultation process. Eighteen guardians did not give con-
sent either because they were not sure of child’s history or
they did not want to enroll the children without their par-
ents consent. Six questionnaires had incomplete informa-
tion. In total, 512 children participated in the study. A
majority (58%) were male and aged between 13 to
59 months (56%), with a median age of 15 months. Chil-
dren older than 1 year had an average of 2.2 (SD2.4) epi-
sodes of ARIs before reaching their first birthday. Those
with ARI spent a mean number of 6 (SD4.1) days with
symptoms before consulting a health centre or hospital.
The proportion of ARIs in children under 5 years
in the BRH was 54.7% (280 children) with a 95% CI
of 50.3%–59.0%. Using IMCI guidelines, a total of
166/280 (59%) were mild ARIs (No Pneumonia), 69/
280 (25%) were moderate ARI (Pneumonia) and 45/
280 (16%) were severe ARI (Severe Pneumonia) as
shown in Fig. 1. The ARIs as diagnosed by consul-
tants were: rhinitis 170/280 (60%%), pharyngitis 120
(43%), tonsillitis 54 (19%), acute otitis media 39
(14%), bronchopneumonia 88 (31%) as shown in Fig. 2.
One hundred and ninety one (37.3%) of the 512 chil-
dren had an URTI (rhinitis, pharyngitis, tonsillitis,
acute otitis media), 88 (17.2%) had a LRTI (broncho-
pneumonia) and 35 had both upper and lower RTI.
Of the 280 children who had ARIs, 118 of them were
also found to have other co-morbid conditions like: mal-
nutrition 51 (18.2%), malaria 25 (8.9%), diarrheal disease
Page 3 of 8
Fig. 1 Proportion of ARI using IMCI definition in children less
than 5 years
26 (9.3%), measles-like rash 8(2.9%), and HIV infection
23 (8.2%) as shown in Fig. 3.
As shown on Table 1, children aged more than
12 months, males, children with low birth weight, poor
paternal education and children with younger fathers
(≤30 years), accounted for a higher proportion of ARIs
than their comparative groups.. However, the difference
was not statistically significant (p > 0.05).
Children with poorly educated mothers had signifi-
cantly higher proportion of ARIs (P < 0.001) with an OR
of 3.13 (95% CI: 2.11–4.64).
The evaluated clinical risk factors (Table 2) revealed that
malnourished children [OR 3.01 (95% CI: 1.66–5.43)] and
children infected with HIV [OR 2.88 CI: 1.21–6.83], had a
significantly higher proportion (P < 0.05) of ARI than well-
nourished and HIV negative children.
Children who were inadequately breastfed and inad-
equately immunized did not have a significantly different
proportion of ARIs when compared those who were ex-
clusively breastfed and immunized respectively. (P > 0.05).
Environmental factors such as exposure to wood
smoke, cigarette smoke, and contact or living with some-
one who had a cough were found to significantly in-
crease the proportion of ARIs (P < 0.05). While the
association of school attendance and overcrowding was
not significant. (Table 3).
After multivariate analysis, all significant variable
remained significant except for the children’s nutritional
status with a p-value of 0.06. Table 4.
Discussion
This study aimed at determining the proportion of ARIs
and identifying some related risk factors in children under
5 years attending the Bamenda Regional Hospital. A high
proportion of ARI of 54.7% was probably because this study
was carried out during the peak of the dry season
(December, January and February) which is characterized
by dry, cold and dusty harmattan winds. Though high, this
result is lower than 69.7% obtained by Sikoilia et al. in
Kenya [15] and 70% obtained by Rhamam in Bangladesh
Tazinya et al. BMC Pulmonary Medicine (2018) 18:7
Fig. 2 Proportion of the different types of ARI as diagnosed by physician
[16]. This is probably because participants in this study
were found to have a lower average of 3.7 ± 4.5 infections a
year, compared to 6–8 episodes obtained in under-five chil-
dren in Nigeria by Ujunwa et al. [4]. The number of hos-
pital visits for ARI(2.1 ± 2.2) compared to the number
episodes of ARIs in our study are similar to findings in a
study in India [17] where only 42.5% of mothers regarded
ARIs as serious enough to present to the hospital.
On the other hand our study found a higher proportion
of ARI compared to the 10–40% in found in other studies
[18]. This differences in the proportions of ARI could be as
a result of different study populations, different study set-
tings, differences in age groups studied, or because this
study used mainly clinical definitions for the cases which is
more sensitive than laboratory confirmed cases. A study
lasting at least one complete calender year could help get
Fig. 3 ARI and co-morbidities
Page 4 of 8
the proportion of infections for a typical year. In order to
reduce this high burden of ARI on the population, the min-
istry of public health in developing countries could include
control of ARIs in their community intervention activities.
The proportion of pneumonia in this study was 22.3%,
higher than the 19.4% for the Northwest Region of
Cameroon as reported in 2004 by Tchatchou [19]. The
proportion of a LRTI in our study (17.35%) is very similar
to the 17.4% found in the Far North Region in 2011 [20]
and higher than the prevalence for the Northwest Region
(9.5%) in the same survey. No particular reason was found
for this differences.
The proportion of pneumonia alone in this study (22.3%)
is higher than the proportion of all LRTI (17.2%) in the
same study. This is because the diagnostic criteria of pneu-
monia according to Integrated Management of Childhood
Tazinya et al. BMC Pulmonary Medicine (2018) 18:7 Page 5 of 8

Table 1 Socio-demographic factors associated with ARI in children under 5 years

Factor Total ARI Odds ratios 95% CI P-value
Age(months)
2–12 225 117(52.00%) 1
13–59 287 163(56.79%) 1.21 0.85–1.72 0.28
Gender
Female 218 113(51.83%) 1
Male 294 167(56.80%) 1.21 0.85–1.72 0.29
Birth weight
Normal 463 251(54.21%) 1
Low birth weight < 2.5 kg 19 12(63.16%) 1.45 0.56–3.74 0.45
Overweight ≥4 kg 30 17(58.62%) 1.19 0.55–2.53 0.66
Mothers age (years)
Age > 20 407 212(52%) 1
Age ≤ 20 20 11(55%) 1.12 0.45–2.7 0.80
Fathers age(years)
Age > 30 303 153(50.50%) 1
Age ≤ 30 108 61(56.48%) 1.27 0.82–1.98 0.28
Mother’s level of education
Secondary + tertiary 316 144(45.57%) 1
None + primary 183 131(71.58%) 3.13 2.11–4.64 < 0.001
Father’s level of education
Secondary + tertiary 330 173(52.42%) 1
None + primary 159 97(61.01%) 1.42 0.97–2.09 0.07

Illnesses (IMCI) guidelines is highly sensitive [14] and will IMCI which does not specify the different types of ARIs
include some false positive cases of pneumonia, made up of but uses the term pneumonia to facilitate management in
children with a severe URTI because of the presence of resource poor settings. Community health workers should
cough, difficulty breathing with or danger signs which are be trained on the use of IMCI guidelines so that they can
sensitive but not specific to pneumonia alone. The propor- recognize ARI early enough and take appropriate actions to
tion of LRTI of 17.2% in our study is similar to 19% in a prevent its spread and severity.
study in India [21]. The diagnostic challenges of respiratory Of the risk factors identified in our study, malnutrition
illnesses in our setting compels many clinicians to use the was found to be significant with an odds ratio of 3.01 (95%
Table 2 Clinical factors associated with ARI
Factor Total ARI Odds ratios 95% CI P-value
Nutritional status
Malnourished 67 51(76.12%) 3.01 1.66–5.43 < 0.001
Normal 445 229(51.45%) 1
HIV status
Positive 30 23(76.67%) 2.88 1.21–6.83 < 0.016
Negative 482 257(53.32%) 1
Immunization status
No/ incomplete vaccination 11 4(36.36%) 0.69 0.20–2.39 0.56
Up to date with EPI 501 227(55.29%) 1
Breastfeeding
Mixed 74 43(58.11%) 1.17 0.71–1.92 0.54
Exclusive 438 238(54.34%) 1
Tazinya et al. BMC Pulmonary Medicine (2018) 18:7 Page 6 of 8

Table 3 Environmental and social factors associated with ARI

Factor Total ARI Odds ratios 95% CI P-value
Exposure to wood smoke
Not exposed 203 82(40.39%) 1
Exposed 309 198(64.08%) 2.63 1.83–3.79 < 0.001
Cigarette smoke
Non passive smoker 474 249(52.53%) 1
Passive smoker 37 31(83.78%) 4.67 1.91–11.40 < 0.001
a
History of contact
No contact 313 134(42.81%) 1
Had contact 199 147(73.87%) 3.78 2.56–5.56 < 0.001
School attendance
Do not go to school 391 210(53.71) 1
Go to school 121 70(57.85%) 1.18 0.78–1.79 0.42
Overcrowding
Not overcrowded 303 167(55.12%) 1
Overcrowded 209 114(54.55%) 0.97 0.69–1.39 0.90
a
contact with someone who has a cough

CI: 1.66–5.43). This finding is consistent with a similar could be attributed to statistical methods because the influ-
study in Nigeria by Ujunwa et al. in 2014 [4] where malnu- ence of malnutrition on ARIs is well known from many dif-
trition was a significant risk factor with a relative risk of ferent studies [18, 21–25]. Supplementation of common
3.33 (95% CI: 2.65–4.21) and Rahman in Bangladesh who foods for children and routine education of mothers during
obtained the prevalence of ARI in malnourished children to vaccination clinics could help address the problem of mal-
be 63.1% (p < 0.001). After multivariate analysis, the nutri- nutrition and reduce the impact of ARIs.
tion status was only marginally significant (p = 0.06) this The prevalence of HIV infection in Cameroon stood at
5.5% by 2007 with 420,000 new infections in children under
Table 4 Multivariate logistic regression analysis of potential risk 15 years [26]. Children who tested positive for HIV in this
factors for ARI
study (30) were more likely to have an ARI than those who
Factor Adjusted Odds ratios 95% CI P-value
were negative (OR 2.88 95% CI:1.21–6.83). Although 14
Nutritional status (45%) of the 31 children who tested positive for the HIV
Normal 1 rapid test (Alere Determine ™ HIV- 1/2) were exposed chi-
Malnourished 1.91 0.97–3.76 0.06 dren, the association of HIV and ARI is expected because
History of contact HIV infection is known to weaken the immune system and
No 1
increase the spectrum of organisms that infect the respira-
tory system [27]. Children who tested positive for the rapid
Yes 3.37 2.21–5.14 < 0.01
HIV test had a higher risk and a poorer outcome than the
Exposure to wood smoke HIV negative children [27, 28]. The presence of the HIV
Not exposed 1 treatment center in the hospital can account for the consid-
Exposed 1.85 1.22–2.78 < 0.01 erably large number of HIV exposed and infected children.
HIV status The diagnosis of HIV using rapid test will include exposed
Negative 1
noninfected children accounting for a large proportion
(8.2) of children diagnosed with HIV.
Positive 2.76 1.05–7.25 0.04
Children from mothers who had no education or pri-
Mother’s level of education mary education only, had a higher chance of developing
Secondary + tertiary 1 an ARI than children from more educated mothers (sec-
Primary + none 2.80 1.85–4.25 < 0.01 ondary education and above). This is probably because
Passive smoking children spend more time with their mothers, and
No 1
mothers’ educational level will determine the quality of
care and many social and environmental factors that the
Yes 3.58 1.45–8.84 < 0.01
child will be exposed to. Ujunwa et al. also found an
Tazinya et al. BMC Pulmonary Medicine (2018) 18:7
association with maternal education but it was signifi-
cant only for LRTI and not for URTI. Other studies have
also found a positive association between poor maternal
education and ARI [4, 16–18, 21, 29]. Infant welfare
clinics could be used as an area to reinforce maternal
health education and care of infants and children.
The odds of developing an ARI after exposure to wood
smoke was 2.63 compared to those who were not exposed.
WHO reports that children who are exposed to cooking
fuels increase the risk of developing pneumonia [1]. A
similar association between wood fuel and ARI has also
been found to be significant in some studies [15, 18, 21,
24, 30, 31]. The community has to be educated on the
dangers of wood smoke especially because it is the main
source of cooking fuel in the local communities.
Passive cigarette smoking from this study, was found
to be a significant risk factor of ARI increasing the odds
by 4.67 (1.91–11.40) compared to children who were not
passive smokers. This is a consistent finding with other
studies [4, 18, 24, 25] in which the risk of passive smok-
ing increased by about 2 to 4 fold that of non-passive
smokers [32]. This association was expected and could
be explained by the fact that smoking destroys the nat-
ural protective mechanism of the respiratory tract mak-
ing it easier for pathogens to overcome the first line
defense of the respiratory system [33]. Anti smoking
campaigns could help sensitise the population on the
dangers of tobacco smoke in general and on the health
of children in particular.
Coming in contact with someone who had symptoms
of respiratory disease significantly increases the risk of a
child to develop an ARI. This result only confirms the
fact that ARIs are communicable diseases transmitted by
droplets from infected persons. This is an association
that has been found in other studies like Ariane et al. in
the Netherlands [29]. Children should be kept away
from people who present with cough so as to prevent
them from getting infected.
The age, and gender of a child in this study did not
significantly affect the proportions of acute respiratory
infections. The meta-analysis by Jackson et al. reported
an inconsistency in the effect of age and gender on ARI
as 4 of the studies reviewed found a significant associ-
ation and 3 others studies agree with our finding in that
they did not also find a significant association of the age
and gender with ARI [30].
The WHO in a report on pneumonia, brings out the im-
portance of low birth weight in the prevalence of ARIs [24].
We did not find any significant association between the
birth weight and ARIs in our study. Similarly, Lira et al., in
Brazil did not find any significant difference between low
birth weight and the prevalence of cough [34]. This is prob-
ably because the effect of low birth weight on ARI is more
significant in neonates and our study excluded neonates.
Page 7 of 8
Factors like inadequate breastfeeding and poor
immunization in our study, are in great contrast with the
results from many other studies [4, 18, 21, 23, 29, 30, 32].
Many breastfed children are given water and other liquids
foods like corn soup frequently before 4 months of life,
classifying them as mixed feeding in this study. Giving clean
water and corn soup to children less than 4 months may
not increase their risk of infection. Children in Bamenda re-
ceive the pneumococcal and Haemophilus influenza type b
vaccines at 6 weeks, 10 weeks and 14 weeks and at
6 months they receive the miseasles vaccine as required by
the EPI calendar. Our study did not find a significant asso-
ciation between vaccination and ARI probably because
some of the inadequately vaccinated children according to
the definition, might have received some doses of the
pneumococcal and Haemophilus influenza type b vaccine
which are known to reduce morbidity and mortality from
ARI [1]. Analyzing nasal swabs could also determing the
specific predisposing germs.
Study limitations
The diagnosis of the various ARIs was made based on
clinical findings and compared to the gold standards is
less sensitive and specific.
This study is a hospital-based study and less than 50%
of children with ARIs go to the hospital for medical care
so the proportion may not be a true reflection of what is
in the community.
A longitudinal study would better illustrate the ef-
fects of the potential risk factors than this cross sec-
tional study.
Conclusion
The proportion of ARI in the BRH was 54.7% and that
of pneumonia was 22.3%. The risk factors significantly
associated with ARI were: infection with HIV, poor ma-
ternal education, passive smoking, exposure to wood
smoke and contact with person having ARI. Measures
taken to abate these conditions will reduce the morbidity
and mortality associated with ARI.
Abbreviations
ARI: Acute Respiratory Infection; BRH: Bamenda Regional Hospital;
CI: Confidence Interval; EPI: Expanded Program of Immunization; HIV: Human
Immunodeficiency Virus; IMCI: Integrated Management of Childhood Illnesses;
LRTI: Lower Respiratory Tract Infection; OR: Odds Ratio; RTI: Respiratory Tract
Infection; SD: Standard Deviation; URTI: Upper Respiratory Tract Infection;
WHO: World Health Organization
Acknowledgements
We are grateful to all the children who took part in the study and their
guardians for accepting to participate. We thank the administration of the
Bamenda Regional Hospital for permitting us to conduct this study.
Funding
This study was not funded.
Tazinya et al. BMC Pulmonary Medicine (2018) 18:7
Availability of data and materials
The datasets used and/or analysed during the current study are available
from the corresponding author on reasonable request.
Authors’ contributions
This work was carried out in collaboration with all authors. Authors AAT, JA, MTO
did the study design and wrote the protocol. Authors LTM, GEHE did the
literature search, cross-checked the statistical analysis and made important inputs
in the drafting of the manuscript. LTM cross-checked the data entry while AAT
and MA analysed the data. GEHE is the corresponding author. All authors read
and approved the final manuscript.
Ethics approval and consent to participate
This study was approved by the Institutional Review Board of the Faculty of
Health Sciences, University of Buea, Cameroon. Participants were not
exposed to any risk by taking part in the study. Parents or guardians signed
a written informed consent form, as approval for their children to be
participants.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
Department of Internal Medicine and Pediatrics, Faculty of Health Sciences
University of Buea, P. O. Box 63, Buea, Cameroon. 2Department of Surgery
and Obstetrics/Gynecology, Faculty of Health Sciences, University of Buea,
P.O Box 12, Buea, Cameroon. 3Department of Public Health and Hygiene,
Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon.
4
Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1,
Yaoundé, Cameroon.
Received: 16 September 2016 Accepted: 9 January 2018
References
1. WHO. Pneumonia, the forgotten killer of children. Geneva 27: UNICEF/WHO;
2006. 10: 92-806-4048-8
2. The UN Inter-agency Group for Child Mortality Estimation . Levels & Trends
in Child Mortality: Report 2014. New York: UNICEF; 2014.
3. Organization WH, UNICEF. Ending preventable child deaths from pneumonia
and diarrhoea by 2025: the integrated global action plan for pneumonia and
diarrhoea (GAPPD). 2013.
4. Ujunwa F, Ezeonu C. Risk factors for acute respiratory tract infections in
under-five children in Enugu Southeast Nigeria. Ann Med Health Sci Res.
2014;4(1):95–9.
5. Mizgerd JP. Lung infection–a public health priority. PLoS Med. 2006;3(2):e76.
6. Nair H, Simoes EA, Rudan I, Gessner BD, Azziz-Baumgartner E, Zhang JS, et
al. Global and regional burden of hospital admissions for severe acute lower
respiratory infections in young children in 2010: a systematic analysis.
Lancet (London, England). 2013;381(9875):1380–90.
7. Einterz EM, Bates M. Causes and circumstances of death in a district hospital
in northern Cameroon, 1993-2009. Rural Remote Health. 2011;11(3):1623.
8. Griggs D, Stafford-Smith M, Gaffney O, Rockstrom J, Ohman MC,
Shyamsundar P, et al. Policy: Sustainable development goals for people and
planet. Nature. 2013;495(7441):305–7.
9. Schluger NW, Koppaka R. Lung disease in a global context. A call for public
health action. Ann Am Thorac Soc. 2014;11(3):407–16.
10. Council BC. Bamenda City profile 2015 [1st February 2015]. Available
from: bamendacity.com/index.php?option=com_content&view=
article&id=61&Itemid=339.
11. Suzuki M, Thiem VD, Yanai H, Matsubayashi T, Yoshida LM, Tho LH, et al.
Association of environmental tobacco smoking exposure with an increased
risk of hospital admissions for pneumonia in children under 5 years of age
in Vietnam. Thorax. 2009;64(6):484–9.
Page 8 of 8
12. Wechsler S. Statistics at Square One. Ninth Edition, revised by M. J.
Campbell, T. D. V. Swinscow, BMJ Publ. Group, London, 1996. No. of pages:
140. ISBN 0-7279-0916-9. Statistics in Medicine. 1997;16(22):2629-30.
13. Selwyn BJ. The epidemiology of acute respiratory tract infection in young
children: comparison of findings from several developing countries.
Coordinated Data Group of BOSTID Researchers. Rev Infect Dis. 1990;
12(Suppl 8):S870–88.
14. Patwari AK, Raina N. Integrated Management of Childhood Illness (IMCI): a
robust strategy. Indian J Pediatr. 2002;69(1):41–8.
15. Sikolia DN, Mwololo K,HC. The prevalence of acute respiratory infections
and the associated risk factors: a study of children under five years of age in
Kibera Lindi village, Nairobi, Kenya. J Natl Inst Public Health. 2002;51(1):32-38
16. Rahman MM, Shahidullah M. Risk factors for acute respiratory infections
among the slum infants of Dhaka city. Bangladesh Med Res Counc Bull.
2001;27(2):55–62.
17. Debasism B, Ahemed T. Study of knowledge, attitude and practice
among mothers towards acute respiratory infection in urban and rural
communitiesof burdwan district, West Bengal, India. Rev Progr. 2013;
1(8):1–6.
18. Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S. Exclusive
breastfeeding reduces acute respiratory infection and diarrhea deaths
among infants in Dhaka slums. Pediatrics. 2001;108(4):e67-e.
19. Tchatchou ND. Variations Regionales de la Survenance des Infections
Respiratoires Aigues chez les Enfants de Moins de Cinq Ans Au Cameroun:
Maters[Dissertation]Yaounde, Universite de Yaounde II; 2011.
20. INS I. Enquête Démographique et de Santé et à Indicateurs Multiples du
Cameroun 2011. Calverton, MD: International I. 2012;423.
21. Mathew JL, Patwari AK, Gupta P, Shah D, Gera T, Gogia S, et al. Acute
respiratory infection and pneumonia in India: a systematic review of
literature for advocacy and action: UNICEF-PHFI series on newborn and
child health, India. Indian Pediatr. 2011;48(3):191–218.
22. Mtango FD, Neuvians D, Korte R. Magnitude, presentation, management
and outcome of acute respiratory infections in children under the age of
five in hospitals and rural health centres in Tanzania. Trop Med Parasitol.
1989;40(2):97-102.
23. Bellos A, Mulholland K, O'Brien KL, Qazi SA, Gayer M, Checchi F. The burden
of acute respiratory infections in crisis-affected populations: a systematic
review. Confl Health. 2010;4:3.
24. WHO. Programme for the control of acute respiratory infections. Acute
respiratory infections in children: case management in small hospitals in
developing countries A manual for doctors and other senior health workers.
Geneva: World Health Organization; 1990.
25. Rahman M, Rahman A. Prevalence of acute respiratory tract infection and its
risk factors in under five children. Age. 1997;23(2):47-50
26. Mbanya D. Current status of HIV/AIDS in Cameroon: how effective are
control strategies? Int J Environ Res Public Health. 2008;5(5):378–83.
27. Zar HJ. Pneumonia in HIV-infected and HIV-uninfected children in
developing countries: epidemiology, clinical features, and management.
Curr Opin Pulm Med. 2004;10(3):176–82.
28. Madhi SA, Petersen K, Madhi A, Khoosal M, Klugman KP. Increased disease
burden and antibiotic resistance of bacteria causing severe community-
acquired lower respiratory tract infections in human immunodeficiency
virus type 1-infected children. Clin Infect Dis. 2000;31(1):170–6.
29. Macedo SE, Menezes AM, Albernaz E, Post P, Knorst M. Risk factors for acute
respiratory disease hospitalization in children under one year of age. Rev
Saude Publica. 2007;41(3):351–8.
30. Jackson S, Mathews KH, Pulanic D, Falconer R, Rudan I, Campbell H, et al.
Risk factors for severe acute lower respiratory infections in children: a
systematic review and meta-analysis. Croat Med J. 2013;54(2):110–21.
31. Morris K, Morganlander M, Coulehan JL, Gahagen S, Arena VC. WOod-
burning stoves and lower respiratory tract infection in american indian
children. Am J Dis Children. 1990;144(1):105–8.
32. Arcavi L, Benowitz NL. CIgarette smoking and infection. Arch Intern Med.
2004;164(20):2206–16.
33. Valencia-Gattas M, Conner GE, Fregien NL. Gefitinib, an EGFR tyrosine kinase
inhibitor, prevents smoke-mediated ciliated airway epithelial cell loss and
promotes their recovery. PLoS One. 2016;11(8):e0160216.
34. Lira PI, Ashworth A, Morris SS. Low birth weight and morbidity from diarrhea
and respiratory infection in northeast Brazil. J Pediatr. 1996;128(4):497–504.